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				logo
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			<td class="title">
				<p style="font-size:20; font-weight:bold;"><?=$school_name;?></p>
				<p style="font-size:12;"><?=$school_address;?></p>
				<p>&nbsp;</p>
				<p style="font-size:14; font-weight:bold;">INTERMEDIATE LEVEL</p>
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				2 x 2 picture
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		<tr><td style="font-weight:bold;">PERSONAL INFORMATION</td></tr>
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			<td>Name of Child:</td><td style="width:245;" class="underline">&nbsp;</td>
			<td>Nickname:</td><td style="width:150;" class="underline">&nbsp;</td>
			<td style="width:100;">&nbsp;</td>
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			<td>Date of Birth:</td><td style="width:120;" class="underline">&nbsp;</td>
			<td>Age:</td><td style="width:35;" class="underline">&nbsp;</td>
			<td>Year:</td><td style="width:35;" class="underline">&nbsp;</td>
			<td>Months:</td><td style="width:45;" class="underline">&nbsp;</td>
			<td style="width:220;">&nbsp;</td>
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			<td>Place of Birth:</td><td style="width:183;" class="underline">&nbsp;</td>
			<td>Nationality:</td><td style="width:95;" class="underline">&nbsp;</td>
			<td style="width:220;">&nbsp;</td>
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			<td>City Address:</td><td style="width:185;" class="underline">&nbsp;</td>
			<td>Tel. Nos.</td><td style="width:95;" class="underline">&nbsp;</td>
			<td style="width:220;">&nbsp;</td>
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			<td>Grade Level:</td><td style="width:185;" class="underline">&nbsp;</td>
			<td>Calendar: AIC</td><td style="width:130;" class="underline">&nbsp;</td>
			<td>Regular</td><td style="width:100;">&nbsp;</td>
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			<td>Religious Affilication: </td><td style="width:270;" class="underline">&nbsp;</td>
			<td style="width:260;">&nbsp;</td>
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			<td>Name of Father: </td><td style="width:170;" class="underline">&nbsp;</td>
			<td>Mother: </td><td style="width:235;" class="underline">&nbsp;</td>
			<td style="width:100;">&nbsp;</td>
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			<td>Occupation: </td><td style="width:197px;" class="underline">&nbsp;</td>
			<td style="width:50;">&nbsp;</td><td style="width:243;" class="underline">&nbsp;</td>
			<td style="width:100;">&nbsp;</td>
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			<td>Office Tel. No. </td><td style="width:176;" class="underline">&nbsp;</td>
			<td style="width:50;">&nbsp;</td><td style="width:235;" class="underline">&nbsp;</td>
			<td style="width:100;">&nbsp;</td>
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			<td>Name of Guardian </td><td style="width:160;" class="underline">&nbsp;</td>
			<td>Relationship to Child </td><td style="width:160;" class="underline">&nbsp;</td>
			<td style="width:100;">&nbsp;</td>
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		<tr><td><span style="font-weight:bold;">STATUS OF PARENTS:</span> (Pls. Encircle) for how long</td></tr>
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			<td>Married </td><td style="width:230;" class="underline">&nbsp;</td>
			<td style="width:250;">&nbsp;</td>
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			<td>Remarried </td><td style="width:230;" class="underline">&nbsp;</td>
			<td style="width:250;">&nbsp;</td>
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			<td>Living Together </td><td style="width:230;" class="underline">&nbsp;</td>
			<td style="width:250;">&nbsp;</td>
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			<td>Single Parent </td><td style="width:230;" class="underline">&nbsp;</td>
			<td style="width:250;">&nbsp;</td>
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			<td>Separated: </td><td>Location</td><td style="width:230;" class="underline">&nbsp;</td>
			<td style="width:250;">&nbsp;</td>
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			<td>&nbsp;</td><td>Legal</td><td style="width:230;" class="underline">&nbsp;</td>
			<td style="width:250;">&nbsp;</td>
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			<td width="40%">ADDITIONAL SIBLING/S</td>
			<td>OTHER HOUSEHOLD MEMBERS (Helpers, Rel.)</td>
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			<td style="width:10;">&nbsp;</td>
			<td style="width:150;" class="underline">&nbsp;</td>
			<td style="width:100;">&nbsp;</td>
			<td style="width:150;" class="underline">&nbsp;</td>
			<td style="width:200;">&nbsp;</td>
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			<td>&nbsp;</td>
			<td class="underline">&nbsp;</td>
			<td>&nbsp;</td>
			<td class="underline">&nbsp;</td>
			<td>&nbsp;</td>
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			<td width="40%">METHODS OF DISCIPLINE:</td>
			<td>WHO DOES THE DISCIPLINE?</td>
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			<td style="width:10;">&nbsp;</td>
			<td style="width:65;" class="underline">&nbsp;</td>
			<td style="width:220;">Spanking</td>
			<td style="width:65;" class="underline">&nbsp;</td>
			<td>Dad</td>
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			<td>&nbsp;</td>
			<td class="underline">&nbsp;</td>
			<td>Grounding</td>
			<td class="underline">&nbsp;</td>
			<td>Mom</td>
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			<td>&nbsp;</td>
			<td class="underline">&nbsp;</td>
			<td>Talking to the Child</td>
			<td class="underline">&nbsp;</td>
			<td>Guardian</td>
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			<td style="width:10;">&nbsp;</td>
			<td style="width:100;" class="underline">&nbsp;</td>
			<td style="width:185;">Others pls. Specify</td>
			<td style="width:100;" class="underline">&nbsp;</td>
			<td>Others pls. Specify</td>
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		<tr><td><span style="font-weight:bold;">FAMILY'S FAVORITE PASTTIME: (Encircle) PLS. SPECIFY:</td></tr>
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			<td>Watching T.V./Movies/Videos</td><td style="width:370;" class="underline">&nbsp;</td>
			<td style="width:80;">&nbsp;</td>
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			<td>Playing Board Game/s</td><td class="underline">&nbsp;</td>
			<td>&nbsp;</td>
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			<td>Computer</td><td class="underline">&nbsp;</td>
			<td>&nbsp;</td>
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			<td>Reading</td><td class="underline">&nbsp;</td>
			<td>&nbsp;</td>
		</tr>
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			<td>Others</td><td class="underline">&nbsp;</td>
			<td>&nbsp;</td>
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			<td>How much time does your child spend in his/her study period?</td><td style="width:230;" class="underline">&nbsp;</td><td style="width:80;">&nbsp;</td>
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			<td>What are your child's responsibilities at home:</td><td style="width:310;" class="underline">&nbsp;</td><td style="width:80;">&nbsp;</td>
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			<td style="width:10;">&nbsp;</td><td style="width:310;" class="underline">&nbsp;</td><td style="width:200;">&nbsp;</td>
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			<td>Is there any particular information that the teacher should be aware of that may hinder or help the child's learning process? <span style="text-decoration:underline;">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></td>
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		<tr><td><span style="font-weight:bold;">FOR FEMALE CHILDREN:</td></tr>
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			<td>Has your child had her first menstruation?</td><td class="all_around">&nbsp;&nbsp;</td><td>No</td><td class="all_around">&nbsp;&nbsp;</td><td>Yes</td><td style="width:300;">&nbsp;</td>
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			<td>What normally signals or accompanies her monthly period?</td><td style="width:330;" class="underline">&nbsp;</td>
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			<td>Do you allow your child to go home independently after class?</td><td style="width:20;" class="all_around">&nbsp;</td><td>No</td><td style="width:20;" class="all_around">&nbsp;</td><td>Yes</td><td style="width:150;">&nbsp;</td>
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			<td>If yes, please affix your signature on the space provided for:</td>
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			<td style="width:200;" class="underline">&nbsp;</td>
			<td style="width:400;">&nbsp;</td>
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	<p></p>
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			<td style="width:20;">&nbsp;</td>
			<td style="width:200;" class="underline">&nbsp;</td>
			<td style="width:200;">&nbsp;</td>
			<td style="width:200;" class="underline">&nbsp;</td>
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			<td>&nbsp;</td>
			<td style="text-align:center;">Date</td>
			<td>&nbsp;</td>
			<td style="text-align:center;">Parent's Name &amp; Signature</td>
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